ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAFAGAHAIAJ
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PLANNED ACADEMIC PROGRAM WORKSHEET
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For use of this form, see CC Pam 145-4, the proponent agency is ATCC-PA-C
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DATA REQUIRED BY PRIVACY ACT STATEMENT OF 1974
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 1. AUTHORITY: Title 10, US Code 2101 and 2104
Do Not Delete
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 2. PRINCIPAL PURPOSE(S): To provide information and data necessary for administering the Army Senior ROTC program, processing, and managing of selected students for commissioning in the Army IAW
School System Code Dropdown List
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 established public law and Army Regulations.SemesterS
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 3. ROUTINE USE(S): To provide a prjected academic plan to determine if the applicant meets the public law requirements of two remaining academic years.QuarterQ
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 4. VOLUNTARY DISCLOSURE AND EFFECT ON INDIVIDUAL NOT PROVIDING INFORMATION: Voluntary information is necessary to determine eligibility of the individual for acceptance,
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 continuance, or discontinuance in the Army ROTC program.
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1. NAME OF STUDENT (LAST, FIRST, MI)
2. ACADEMIC MAJOR
3. AS OF DATE (MM/DD/YYYY) (Date of form preparation)
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4. INSTITUTION OF ATTENDANCE AND IDENTIFICATION
5. CREDIT HOURS
 6. GRADE POINT AVERAGE (GPA)
Do Not Delete
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a. Name:
Select Semester or Quarter (S/Q)
S Term: Term:
5. CREDIT HOURS - Semester
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b. Identification (Check one):
Host
a. Total required for degree:
Curr GPA:CUM:Curr GPA:CUM:
a. Total required for degree:
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Extension Center
(1) ROTC Hours that do not count:
 Term: Term:
(1) ROTC Hours that do not count:
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Cross-Enrolled
(2) Total Hours Rqd for NAPS:
0Curr GPA:CUM:Curr GPA:CUM:
(2) Total Hours Rqd for NAPS:
0k15
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c. If attendance is at an extension center or cross-enrolled school,
Normal Academic Progression Standard
0.00 Term: Term:
Normal Academic Progression
0.00k16
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list the name of the Host Institution:
b. Transfer Credits accepted:
Curr GPA:CUM:Curr GPA:CUM:
b. Transfer Credits accepted:
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c. Credits toward degree Comp to date:
 Term: Term:
c. Credits toward degree Comp to date:
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d. Reamining for Degree:
0Curr GPA:CUM:Curr GPA:CUM:
d. Reamining for Degree:
0k19
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e. Number of authorized S/Qs:
0 Term: Term:
e. Number of authorized semesters:
0.00k20
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 Curr GPA:CUM:Curr GPA:CUM:
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 7.TERM, YEAR, COURSE NUMBER, COURSE TITLE, COURSE CREDIT HOURS, CREDITS THAT COUNT TOWARDS ACADEMIC DEGREE, AND ACHIEVED GRADES.
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a.b.c.
5. CREDIT HOURS - Quarter
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Term:Year:Term:Year:Term:Year:
a. Total required for degree:
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No.Course TitleHrs.Cts.Grd.No.Course TitleHrs.Cts.Grd.No.Course TitleHrs.Cts.Grd.
(1) ROTC Hours that do not count:
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(2) Total Hours Rqd for NAPS:
0k15
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Normal Academic Progression
0.00k16
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b. Transfer Credits accepted:
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c. Credits toward degree Comp to date:
5.0k18
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d. Reamining for Degree:
-10k19
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e. Number of authorized quarters:
0.00k20
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Total Term Hours:00Total Term Hours:00Total Term Hours:00
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d.e.f.
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Term:Year:Term:Year:Term:Year:
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No.Course TitleHrs.Cts.Grd.No.Course TitleHrs.Cts.Grd.No.Course TitleHrs.Cts.Grd.
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Total Term Hours:00Total Term Hours:00Total Term Hours:00
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 8. STUDENT INITIALS & DATE:TERM 1:TERM 4:TERM 7:
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(Have the student initial and date beside each
TERM 2:TERM 5:TERM 8:
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term to indicate they have been counseled)
TERM 3:TERM 6:TERM 9:
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CC Form 104-R, DEC 04
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